Provider Demographics
NPI:1144838558
Name:YOO, SEWON (PHYSICAL THERAPY)
Entity type:Individual
Prefix:
First Name:SEWON
Middle Name:
Last Name:YOO
Suffix:
Gender:F
Credentials:PHYSICAL THERAPY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4528 SMART ST APT 1B
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-2283
Mailing Address - Country:US
Mailing Address - Phone:646-897-6163
Mailing Address - Fax:
Practice Address - Street 1:4528 SMART ST APT 1B
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-2283
Practice Address - Country:US
Practice Address - Phone:929-291-0549
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-21
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY04079-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist